Individual
JOHN MARK DIMICHELE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
2015-02134
NC
2080A0000X
Pediatric Adolescent Medicine Physician
0420009297
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
28911
BLUE CROSS BLUE SHIELD
VT
05
—
OVN1356
—
VT
Enumeration date
03/01/2007
Last updated
11/03/2022
Update your record
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